Chap47 PCNL

  1. What is simple and compound calyx?
    If only one papilla drains into a minor calyx, it is described as as imple calyx.

    When there are two or more papillae entering the calyx, it is termed a compound calyx.

    The outermost wall of the calyx, into which the papilla is set, is the calyceal fornix. There are 5 to 14 minor calyces in each kidney (mean of 8, with 70% of kidneys having 7 to 9 minor calyces).

    Compound calyces are the rule in the upper pole, are common in the lower pole, and are rare among the middle calyces.
  2. Brodel and Hodson type kidney?
    • Brödel-type kidney -  this unit is rotated anteriorly, such that the posterior calyces are about 20 degrees behind the frontal plane and the anterior calyces are 70 degrees in front of the frontal plane. The posterior calyces are lateral, and the anterior calyces are medial in this case.
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    • Hodson-type kidney - is the opposite; the calyceal pairs are rotated posteriorly,with the posterior calyces 70 degrees behind the frontal plane and appearing medial and the anterior calyces 20 degrees in front of the frontal plane and appearing lateral.
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    Most right kidneys have a Brödel-type orientation (posterior calyces are lateral), and most left kidneys have a Hodson-type orientation (posterior calyces are medial).
  3. Where to puncture in PCNL?
    The potential for arterial injury is least in Brödel’s line, an avascular plane approximately at the lateral margin of the kidney. 

    The safest place to percutaneously access the collecting system is directly into the calyceal fornix because this will avoid the interlobar (infundibular) arteries adjacent to the calyceal infundibula and the arcuate arteries that skirt the renal pyramid
  4. Types of access needle in PCNL?*UI
    • Initial puncture needle - 3-Part Bevel Tip 
    • Initial puncture needle - 2 Part Trocar Tip 
    • Chiba Needle - Three Part Bevel Tip
  5. Types of PCNL Tract Dilators?*
    • Fascial dilators 
    • Screw dilators 
    • Amplaz dilators 
    • Telescopic metal dilators (Alken dilators)
    • Baloon dilators
  6. Fascial dilators?*
    • Available from 6-16 PTFE 
    • Cheap
    • More bleeding - each dilator is removed and replaced by larger dilater, chance of loss of tamponade is lost during removal
  7. Screw dilators?*
    Available in 3 size - 6-12 Fr, 6-14 Fr, 6-16 Fr
  8. Amplaz renal dilator?*
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    • Radio-opaque dilators and sheath. 
    • Cobra catheter - 8F 
    • Length of amplaz dilator - 30, 32 and 40cm 
    • Length of amplaz sheath - 20, 30 cm 
    • Diameter of amplaz dilator/sheath - 12-30 Fr

    Once puncture is made, guidewire is passed, tract is dilated upto 10F by using a serial fascial dilators 6-8-10 Fr. Then cobra catheter (8Fr) is passed in PCS. Over this catheter, Amplaz dilators are passed sequentially. Once the desired dilatation is acheived by a dilator, over it corresponding amplaz sheath is passed and dilator is removed.
  9. Metallic serial telescopic dilators?*
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    • Consists of central rod and serial metalic dilators 
    • Rod is 58 cm 
    • The entire unit resembles an assembled collapsed radioantenna after all dilators are assembled 
    • Alken rod - 7 Fr with rounded knob which is 9Fr
    • Dilators available - in increment of 3 Fr starting from 9 Fr to 30 Fr. 
    • The inner end of each dilator is designed in such a way that it does not go beyond the previous dilator hence beyond the knob of the rod. 
    • On withdrawing the rod, all the dilators come out with the rod.
  10. Nephroscopes by Storz?*
    • Angle - 6 degree 
    • Size - 22,24,26 F 
    • Cannot be used without sheath unlike Wolf Nephroscopes
  11. Miniperc and Microperc, Ultramini Perc ?*
    • Miniperc - < 20 Fr 
    • Ultra mini PCNL - 3.5 Fr Telescope, 6 Fr Sheath
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Chap47 PCNL